Aged & Disabled Medicaid Waiver Assisted Living Rates for Individuals Qualified under the Waiver January 1, 2008 -December 2008

Aged & Disabled Medicaid Waiver Assisted Living Rates for Individuals Qualified under the Waiver January 1, 2008 through December 31, 2008 (Refer to Section III for payment changes)

RURAL RATES

† Providers are paid for day of discharge	Room & Board Paid By Client	Level 40 RURAL SINGLE OCCUPANCY	Level 41 RURAL MULTIPLE OCCUPANCY
Report on Turnaround Document, MC-4 Total NH days All out of facility days Failure to timely report resident medical absences to Services Coordinator and on MC-4 may result in sanctions	Multiple Occupancy Prior HHS Approval Consent signed	TOTAL AMOUNT RECEIVED FROM CLIENT AND MEDICAID (Minus any Share of Cost) Not pro-rated Notice from Medicaid Eligibility Worker	TOTAL AMOUNT RECEIVED FROM CLIENT AND MEDICAID (Minus any Share of Cost) Not pro-rated Notice from Medicaid Eligibility Worker
ON-GOING MONTHLY RATES
STANDARD (Std.)	$577.00	$2088.00	$1677.00
TRUST FUND (TF)	$577.00	$1984.00	$1593.00
ADMISSION & DISCHARGE MONTHS
Daily STANDARD rate for all days client is physically present	$577.00 Pro-rated	$49.68	$36.16
Daily TRUST FUND rate for all days client is physically present	$577.00 Pro-rated	$46.26	$33.40

URBAN RATES

† Providers are paid for day of discharge	Room & Board Paid By Client	Level 42 URBAN* SINGLE OCCUPANCY	Level 43 URBAN* MULTIPLE OCCUPANCY
Report on Turnaround Document, MC-4 Total NH days All out of facility days Failure to timely report resident medical absences to Services Coordinator and on MC-4 may result in sanctions	Multiple Occupancy Prior HHS Approval Consent signed	TOTAL AMOUNT RECEIVED FROM CLIENT AND MEDICAID (Minus any Share of Cost) Not pro-rated Notice from Medicaid Eligibility Worker	TOTAL AMOUNT RECEIVED FROM CLIENT AND MEDICAID (Minus any Share of Cost) Not pro-rated Notice from Medicaid Eligibility Worker
ON-GOING MONTHLY RATES
STANDARD (Std.)	$577.00	$2359.00	$1893.00
TRUST FUND (TF)	$577.00	$2241.00	$1798.00
ADMISSION & DISCHARGE MONTHS
Daily STANDARD rate for all days client is physically present	$577.00 Pro-rated	$58.59	$43.27
Daily TRUST FUND rate for all days client is physically present	$577.00 Pro-rated	$54.71	$40.14

*Urban Counties - Cass, Dakota, Dixon, Douglas, Lancaster, Sarpy, Saunders, Seward and Washington Counties

Facility will collect Room and Board from the client. This amount must be prorated for clients whose “Prior Authorization for Assisted Living Waiver Service”is for a partial month. Medicaid does not pay for room and board. Each client is financially responsible for his/her own room and board with funds received from any of several sources, such as, Social Security benefits, Supplemental Security Income (SSI) retirement/pension or a HHS grant (Aid to the Aged, Blind or Disabled/AABD or State Supplemental).
The client may have a“Share-Of-Cost”(POS) that must be obligated before HHS will assume financial responsibility for the service component. The client, waiver facility, and Services Coordinator receive a“Notice of Finding”from the Medicaid Eligibility Worker. The POS amount will also be indicated on the Turnaround Billing Document (MC-4). The POS is NOT pro-rated; the full amount must be paid before Medicaid payment is figured. The POS is always taken out at the location the client is at the beginning of the month. Any change in amount as identified in the Notice goes into effect the following month.
The MC-4 includes the TOTAL amount Medicaid will pay. (Per day equivalent x number of days in the month minus any POS/Share-Of-Cost).
The total amount received by facility each month may be slightly more or slightly less than the figure in #1 on the above chart, depending on the number of days in the month.
Waiver clients retain a personal need allowance of $60 per month. In some cases this amount may vary, refer to Medicaid Eligibility Worker for questions.
Urban rates apply to facilities in Cass, Dakota, Dixon, Douglas, Lancaster, Sarpy, Saunders, Seward and Washington counties.
Multiple occupancy requires:
1. prior approval by HHS
2. consent form signed by the client and roommate
Trust Fund Grantees must maintain specified occupancy levels of Medicaid beneficiaries for a period of 10 years.
Refer to the Assisted Living Provider Handbook for detailed instructions.

† The facility must notify the Services Coordinator by the next working day of a medical absence in which a client is admitted to a hospital or nursing facility. This notice is required in order for the Services Coordinator and Central Office to determine continued appropriateness of the assisted living authorization. Failure to report medical absences to the Services Coordinator may result in the facility being required to reimburse the Department for days the client was out of the facility for medical reasons.